Endovascular Repair for Retrograde Type A Intramural Haematoma with Intimal Tear in the Descending Thoracic Aorta
Journal
European Journal of Vascular and Endovascular Surgery
Journal Volume
60
Journal Issue
3
Pages
386-393
Date Issued
2020
Author(s)
Abstract
Objective: The current treatment for acute retrograde type A intramural haematoma (IMH) remains challenging. Aortic remodelling in both the ascending aorta (AA) and descending thoracic aorta (DTA) was evaluated and the 30 day and mid term outcomes were determined in patients who underwent thoracic endovascular aneurysm repair (TEVAR) for retrograde type A IMH with a primary intimal tear or ulcer like projection in the DTA Methods: This was a retrospective, multicentre observational study. Clinical data, including post-operative mortality and adverse event, aorta related re-intervention, aortic remodelling, and the survival rate of 18 non-consecutive patients with acute retrograde type A IMH undergoing TEVAR between June 2006 and March 2018 were reviewed. Results: The median age at repair was 58.1 years (range 38–86) and 14 (78%) were men. Eight patients (44%) presented with haemopericardium, and 10 (56%) underwent TEVAR within 24 h. The mean IMH thickness and AA diameter were 10.4 ± 3.6 and 45.7 ± 4.6 mm, respectively. Among all patients with acute retrograde type A IMH, 11 patients presented with classical type B aortic dissection and seven with type B IMH. All procedures were technically successful. The median follow up was 28.7 months (range 7–78). No 30 day mortality was observed. Three patients developed post-procedure adverse events. Of these, two patients had neurological events, with one each having cerebrovascular and spinal cord infarction individually, and the third patient required long term haemodialysis with ventilator support. The overall survival rate was 100%. The maximum diameter of the AA and the IMH in the AA significantly decreased after TEVAR. Aortic remodelling was also observed in the DTA along the length of TEVAR coverage. Conclusion: In selected patients with acute retrograde type A IMH, TEVAR offered a treatment alternative to open surgical grafting and medical follow up. ? 2020 European Society for Vascular Surgery
SDGs
Other Subjects
abdominal aortic aneurysm; adult; aged; all cause mortality; aortic diameter; aortic dissection; artery injury; artery intima; Article; brain infarction; clinical article; clinical outcome; clinical study; cohort analysis; computer assisted tomography; contrast enhancement; descending aorta; endovascular aneurysm repair; female; follow up; heart tamponade; hematoma; hemodialysis; hemopericardium; human; intimal tear; left common carotid artery; left subclavian artery; male; neurological complication; observational study; overall survival; postoperative complication; postoperative period; priority journal; retrograde type A intramural hematoma; retrospective study; spinal cord infarction; surgical mortality; survival rate; thoracic aorta; thoracic aortic surgery; transesophageal echocardiography; transthoracic echocardiography; type B aortic dissection; ulcer; acute disease; adverse event; aortic disease; blood vessel prosthesis; blood vessel transplantation; clinical trial; devices; diagnostic imaging; endovascular surgery; hematoma; middle aged; multicenter study; pathophysiology; postoperative complication; risk factor; stent; Taiwan; thoracic aorta; time factor; treatment outcome; vascular remodeling; very elderly; Acute Disease; Adult; Aged; Aged, 80 and over; Aorta, Thoracic; Aortic Diseases; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Hematoma; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; Stents; Taiwan; Time Factors; Treatment Outcome; Vascular Remodeling
Publisher
W.B. Saunders Ltd
Type
journal article